<link rel="stylesheet" media="screen" type="text/css" href="<?php echo bu("css/datepicker.css"); ?>" />
<script type="text/javascript" src="<?php echo bu("js/datepicker.js"); ?>"></script>
<script>
		$(function() {
      $( "#datepicker" ).datepicker({
        changeMonth: true,
        changeYear: true,
        yearRange: '1900:2011',
        dateFormat: 'd MM yy',
      });
    });
</script>

<div class='mainContainer home'> <!-- Main div for the contain, behaves like a table-->
	<div><!-- Direct child of mainContainer, behaves like a table cell-->
		<?php // echo $this->renderPartial('/partials/_notifications'); ?>
		<h2 class='differentAlign'>CCIHT Registration Form</h2>
		<div class='spacer'>&nbsp;</div>

		<?php
      $form=$this->beginWidget('CActiveForm', array(
      'action' => bu('users/cciht'),
      'htmlOptions' => array(
          'name' => 'myForm',
          'class' => 'myForm',
          )
      ));
    ?>
      <?php echo $form->errorSummary($model); ?><br />

      <fieldset>
        <legend>Additional Information</legend>
        <table>
          <tr>
            <td><label>Name/Nama</label></td>
            <td>
              <?php echo $form->dropDownList($model,'nick', array('Mr' => 'Mr', 'Mrs' => 'Mrs', 'Ms' => 'Ms')); ?>
              <?php echo $form->error($model,'nick'); ?>

              <?php echo $form->textField($model, 'name', array('class' => 'full', 'required' => 'required', 'style' => 'width:248px;')); ?>
              <?php echo $form->error($model, 'name'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Institution/Lembaga</label></td>
            <td>
              <?php echo $form->textField($model, 'institution', array('class' => 'full', 'required' => 'required')); ?>
              <?php echo $form->error($model, 'institution'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Membership/Keanggotaan</label></td>
            <td>
              <?php echo $form->dropDownList($model,'membership_type', array('Member' => 'Member', 'Non Member' => 'Non Member')); ?>
              <?php echo $form->error($model,'membership_type'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Position/Jabatan</label></td>
            <td>
              <?php echo $form->textField($model, 'position', array('class' => 'full', 'required' => 'required')); ?>
              <?php echo $form->error($model, 'position'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Address/Alamat</label></td>
            <td>
              <?php echo $form->textField($model, 'address', array('class' => 'full', 'required' => 'required')); ?>
              <?php echo $form->error($model, 'address'); ?>
            </td>
          </tr>
          <tr>
            <td><label>City/Kota</label></td>
            <td>
              <?php echo $form->textField($model, 'city', array('class' => 'full', 'required' => 'required')); ?>
              <?php echo $form->error($model, 'city'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Code/Kode</label></td>
            <td>
              <?php echo $form->textField($model, 'code', array('class' => 'full', 'required' => 'required')); ?>
              <?php echo $form->error($model, 'code'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Phone/Telp</label></td>
            <td>
              <?php echo $form->textField($model, 'phone', array('class' => 'full', 'required' => 'required')); ?>
              <?php echo $form->error($model, 'phone'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Email</label>
            <td>
              <?php echo $form->textField($model, 'email', array('class' => 'full', 'required' => 'required')); ?>
              <?php echo $form->error($model, "email"); ?>
            </td>
          </tr>
          <tr>
            <td><label>Delivery Model Options/Pilihan Program</label></td>
            <td class="checkbox">
              <?php
                echo CHtml::activeCheckboxList(
                  $model, 'delivery_type',
                  array(
                    'Classroom Training, Seminar & Workshop' => 'Classroom Training, Seminar & Workshop',
                    'Strategic Planning Meeting & Management Consultation Services' => 'Strategic Planning Meeting & Management Consultation Services',
                    'Survey, Research & Project' => 'Survey, Research & Project',
                    'Christian School Accreditation info' => 'Christian School Accreditation info',
                  ),
                  array('template'=>'{input} {label}')
                );
              ?>
            </td>
          </tr>
          <tr>
            <td><label>Selected Topic/Services/Pilihan Program/Layanan</label></td>
            <td>
              <?php echo $form->dropDownList($model,'selected_topics', array(
              'A Big Picture: Bible Integration, Christian Worldview, & Character Building' => 'A Big Picture: Bible Integration, Christian Worldview, & Character Building',
              'Building the Character of Your Students: The Nature, Methods, & Programs of Character Building' => 'Building the Character of Your Students: The Nature, Methods, & Programs of Character Building',
              'Walking with God in the Classroom' => 'Walking with God in the Classroom',
              'Classroom Management' => 'Classroom Management',
              'Teaching Reading and Spelling Effectively' => 'Teaching Reading and Spelling Effectively',
              ), array('class' => 'full', 'style' => 'width:300px;')); ?>
              <?php echo $form->error($model, 'selected_topics'); ?>
            </td>
          </tr>
          <tr>
            <td><label>Number of Participants<br />/Jumlah peserta</label></td>
            <td>
              <?php echo $form->textField($model, 'number_participants', array('class' => 'full', 'required' => 'required', 'style' => 'width:190px;')); ?>
              <?php echo $form->error($model, 'number_participants'); ?>
              &nbsp;(persons/orang)
            </td>
          </tr>
        </table>
      </fieldset>

      <fieldset>
        <legend>Please confirm captcha correctly</legend>
        <?php $form->widget('CCaptcha'); ?><br />
        <?php echo $form->textField($model, 'verifyCode'); ?>
        <?php echo $form->error($model, "verifyCode"); ?>
      </fieldset>

			<input type='submit' value='Submit' />
			<input type='submit' value='Reset' />
		<?php $this->endWidget(); ?>
	</div>

    <div class='rightPane'>
		<h2 class='differentAlign'>Our <span class='differentHeading'>Contact</span></h2>
		<div class="contact">
			<h3>ACSI Head Quarters</h3>
      731 Chapel Hills Drive Colorado Springs<br />
      CO 80920.3949<br />
      Phone : +1.719.528.6906<br />
      Fax : +1.719.531.0631<br />
      Email : info@acsiglobal.org
		</div>
    <div class="contact">
			<h3>ACSI Indonesia</h3>
      Komplek Ruko Klampis Megah B-25<br />
      Jl. Klampis Madya Utara I/6<br />
      Surabaya - Jawa Timur 60117<br />
      Phone/Fax : +62.31-591.0897, 591.3068<br />
      Phone : +62.31-592.9902<br />
      Mobile : +62.31-8193.5548<br />
      Email : acsi-indonesia@acsi.or.id<br />
      http://acsiglobal.org; acsi.or.id
		</div>
    <div class="contact">
			<h3>Indonesia Representative Office</h3>
      <b>Jakarta</b><br />
      Jl. Kwitang Raya No. 4, 3rd Floor<br />
      Senen - Jakarta Pusat 10420<br />
      Phone/Fax : +62.21-391.1207<br />
      Mobile : +62.31-3631-8020<br />
      Email : acsi-jakarta@acsi.or.id
		</div>
	</div>
</div>

<div class='spacer'>&nbsp;</div>